This Post will be updated as new-information arises
Hospital Non-Invasive Machines can be Adapted for Invasive Ventilation
Issues:
Most machines are single tube circuits that allow exhalation from a vented mask. If hooked up to an ETT, you need an exhalation port and it must be proximal to a viral filter. Many of the companies sell circuits purpose-built for this, for example:
If not, items can be adapted to this use by Respiratory Therapy. Key is anything venting to the environment is filtered
Home BiPAP/CPAP Machines
- Same deal as above
- Sinai's Research Page on Adapting Home CPAP Machines
- Adapting the V60
Back-Up Ventilators
Many chronically vented patients have their primary ventilator and a back-up in their homes. If they want to help, their community, a loan of these back-up ventilators would be helpful.
Oxygen Powered Commercial CPAP Devices
Like the Boussignac device, Pulmodyne Go-PAP,
and similar devices
Intensive Blog's take on NHS Guidance on CPAP
Anesthesia Machines
Oxylator
See the EMCrit Post
With a PEEP cap in place, these will replace a ventilator
EMCrit CPAP Set-Up
can be used for invasive CPAP through an ETT for patients who are awake and spontaneously breathing freeing up the ICU ventilators for patients requiring mandatory breaths.
see video describing set-up on EMCrit COVID Airway Post
This will not be as comfortable as a legit machine, but it should get the job done
Vortran Garbage Disaster Vents
Splitting Non-Invasive CPAP
Listen to the Wee below for more on this…
Should work on invasive CPAP as well
Helmet CPAP
Splitting Ventilators
This seems absolutely a last resort situation. SCCM has released a guidance document saying the same:
- SCCM Statement on Vent Splitting
- PULMCrit Retort to the SCCM Statement
- Read Jack Iwashyna take on the issue
- Columbia White Paper
If it has to be done, there are a number of sources for info on the FOAMverse. Josh released his thoughts in his PULMcrit Post.
Additional Vent Splitting Resources
Also see the work of Tobin Greensweig at his blog and on youtube.
And this one from Illinois
On to the Wee with Marco Garrone
Marco is an EM Doc in Turin, Italy. They are fully in the surge and have split vents for NIPPV.
Podcast: Play in new window | Download (Duration: 9:34 — 9.1MB) | Embed
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Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
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Superb talk with Marco. I´m from Brazil , and the covid 19 cases are beginning to increase in south america..
Its not the first time that i listen how well these ,patients can go on Non invasive ventilation, Unfortunately, here ,because of a lack of resources , especialy EPI, NIV is almost banned.
And we are going to face a huge problem due to limited number of vents, besides icu beds and staff.
Cheers from Brasil Scott,
I feel if I was in a situation with limited ventilators that an easier Solution would be to connect a combination of oxygen source, peep valve, virus filter To the bag and use an oxygen blender and pulse ox to adjust oxygen delivery. You could easily train lower level medical or even laypeople to bag indefinitely. . This could even be done outside the ICU but if in the ICU you could use waveform capnography to adjust the ventilation rate. A Phone metronome could be set to prompt the person bagging At the the appropriate rate. I don’t think we… Read more »
[…] EMCrit: Alternatives to Vent Splitting and the Safest Vent Splitting Methods in COVID19 […]
I am an ED/critical care physician in Michigan’s UP. We are pretty alone if the surge hits here however we have had time plan. I met with our RT’s last week and have come up with a way to use our V60 NIVV as PC ventilators with a filter on the exhalation port. In addition we talked about the splitting and came to the same conclusion that VC ventilation has a lot of risk associated with it and we should use CPAPor very low Pressure support, but I thought that APRV or bivent might be an option, any thoughts on… Read more »